CHAPTER ONE

ASSESSMENT OF PATIENT CARE

The first phase of the nursing process is assessment. It is a systemic process and includes

collection of accurate data through, interviews of patient, studying of records, reports from

diagnostic investigations such as x-ray and other document as well as through

observations, physical examination. This information gathered will help the nurse to give

holistic care to the client.

Patient Particulars

Fati Awudu is a 1year 4 month old girl born on the 26th of September 2008 at Nigeria but

comes from Serwaba. She now stays at Serwaba a suburb of Kumasi in the Ashanti region.

She is a Muslim. She is the only child of her parents. According to her aunty, Fati’s mother

passed away during delivery which made the aunty to take care of her. She lives with her

aunty at Serwaba. Fati’s next of kin is her aunty. She has not started schooling yet.

Family Medical and Socio- Economic History

The family of Fati Awudu has no known disease of genetic origin. Also there are no

known chronic infectious conditions such as measles, tuberculosis, asthma, epilepsy,

mental disorders and chicken pox. There is no known allergy in the family

Socio-economically, Fati Awudu is a child and cannot earn income. She is being taking

care by her mother’s sister and the brother is working to take care of her (Fati Awudu). Fati

is not a registered member of the National Health Insurance Scheme.

1
Patient’s Developmental History

Fati Awudu was delivered at the hospital and she was immunized against the six childhood

diseases such as, Poliomyelitis, Measles, and Tetanus. According to client’s aunty, client’s

mother did not experience any disorder or complication during. She attended the antenatal

clinic and had no problems through out the months of her pregnancy. She delivered

spontaneously per vagina. She was exclusively breastfed by her aunty for six months and

still continuing with the breast feeding.

Patient’s Lifestyle and Hobbies

According to client’s aunty, client usually gets up early in the morning as soon as she

(aunty) wakes up. Client’s aunty cleans her teeth once daily with cotton and toothpaste.

The aunty baths her with warm water and grooms her around 7:00 am each day. Fati

Awudu always plays with toys and does not like crying, but only cries when she is hungry.

Client normally enjoys maize porridge with milk.

Past Medical History

Information gathering from family and both parent reveals that apart from minor fever that

subsides after administration of syrup paracetamol there has not been any major illness that

demands hospitalization.

Present Medical History

Patients became sick 2days ago when she develops fever which was of low grade and

worsen in the cause of the day. The fever occurred together with cough. The child became

2
very weak on the second day and was sent to Manhyia Hospital and was later referred to

Komofo Anokye Teaching Hospital, where she was admitted to the Paediadric Emergency

Unit (PEU) with a provisional diagnosis of severe malaria. She was later transferred to

ward C5 from Paediatric Emergency Unit with a final diagnosis of Bronchopneumonia.

ADMISSION OF PATIENT

Client was admitted to ward C5 on 12th January, 2010 at 7:30pm as a trans-in case from

Paediatric Emergency Unit (PEU) with Bronchopneumonia under the care the of Dr.

Owusu. She came to the ward carried at her mother’s back accompanied by a student nurse

Client and mother were warmly welcomed into the ward. The mother was offered a seat

and the client was admitted into a warm comfortable bed. She was alert and conscious but

looked ill and mother looked very anxious on admission.

The client’s folder was collected and cross checked with the name and condition for

confirmation. Client’s particulars such as name, sex, age, occupation of mother, address

and religion were documented into the Admission and Discharge book, Daily changes and

Daily ward state. Her vital signs included temperature, pulse, respiration were taken and

recorded as follows

Temperature – 36.0 degree Celsius

Pulse - 122 beat per minute

Respiration - 24 cycles per beat

Weight - 10.5 kilo grams

3
General observation was done which revealed that client looked small per age and

according to the mother, client had lost weight as a result of sudden illness. Due to the

anxious state of mother, she was reassured that her child’s condition was manageable and

will improve with the presence of competent staff. This was done to establish a good

therapeutic relationship between the mother and staff.

The mother was then introduced to other patients on the ward. She was orientated to the

ward it’s environment. Mode of payment was also explained to her because client had no

National Health Insurance.

Fati came into the ward with the following investigations done. They included; Blood for

culture and sensitivity, blood film for malaria parasite and full blood count. She also came

with the following treatment;

 Intravenous ringers lactate

 Injection quinine 120mg state then 60mg tds x 3

 Injection ampicillin 125mg tid x 7

 Injection crentamycin 46mg tid x 7

The following investigation were ordered Full Blood Count, Blood Film, chest x-ray,

grouping and cross matching

4
Patient Concept of Her Illness

According to the mother, child’s illness was not as a result of any spiritual factor but

believed that human being are bound to fall sick once in a lifetime

She however believed, with the competent staff of the hospital and effective management

as a well as their maximum co-operation her child was going to recover successfully

5
LITERATURE REVIEW ON BRONCHOPNEUMONIA

Pneumonia is an acute inflammation of the lung parenchyma “Pneumonia” is a more

general term that describe an inflammatory process in the lung tissue that may predispose a

patient to or place apt at risk for microbial invasion

Incidence

It occurs in all ages and both genders resulting in almost 70,000 deaths per year in persons

65years of ages and older, estimates of the incidence of pneumonia rangers from four (4) to

five (5) million cases per year with approximately twenty five percent (25%) requiring

hospitalization. It is the fifty leading cause of death among the elderly and debilitated

(Bacterial pneumonia)

Aetiology

Pneumonia can be caused by many infectious agents such as pseudomonas aeruginosa,

klebisella species, staphylococcus, aureus, haemophilus influenza, staphylococcus

pneumoniae, enteric gram – negative bacilli fungi and virus (common in children) other

causes includes; inhalation of infectious particles aspiration of oropharyngeal or gastric

contents, haematogenous deposition which is uncommon, direct inoculation as a result of

surgery (this is rare) chronic lung disease.

Classification of Pneumonia

There are three (3) classification of pneumonia according to disease agent, location and

type.

6
 a. Bronchial : Involving the bronchial tube and alveoli

b. Lobar : Involving the entire lobe

c. Lobular : Involving part of the lobe

Pneumonia is also referred to as primary when it result from inhalation or aspiration of a

pathogen or secondary, when it involves spread of bacteria from another location.

Pathophysiology

Upper airway characteristic normally prevent potentially infectious particles from reaching

the normally, sterile lower respiratory tract. This patient with pneumonia caused by

infectious agents often has an acute or chronic underlying disease that has impair host

defences.

Pneumonia arises from normally present flora in a patient whose resistance has been

cratered or it results from aspiration of flora present in the orpharynx. It may also result

from blood-borne organisms and are trapped in the pulmonary capillary bed, becoming a

potential source of pneumonia

Pneumonia often affects both ventilation and diffusion. An inflammatory reaction can

occur in the alveoli, producing exudate that interferes with the diffusion of oxygen and

carbon dioxide. White blood cells mostly neutrophils, also migrate into the alveoli and fill

the normally air-containing space. Areas of the lungs are not adequately ventilated because

of secretions and mucosal oedema that cause partial occlusion of the bronchi or alveoli

7
with a resultant decrease in alveolar oxygen tension. Bronchospasm may also occur in

parts with reactive airway disease. Because of hyperventilation, a ventilation perfusion

mismatch occurs in the affected area of the lung.

Venous blood entering the pulmonary circulate passes through the under ventilated area

and exists to the left side of the heart poorly oxygenated. The mixing of oxygenated and

unoxygenated or poorly oxygenated blood eventually results in arterial hypoxaemia. If a

substantial portion of one or more lobes is involved, the disease is referred to as “Lobar

pneumonia”. The term “Bronchopneumonia” is used to describe pneumonia that is

distributed in a patchy fashion having originated in one or more localized area within

surrounding lung parenchyma. Bronchopneumonia is more common than lobar pneumonia.

Clinical Features

 There are chills

 There is fever

 There is chest pain

 Dyspnoea is present

 There is cough

 Tachypnoea with intercostals recession

 The sputum may be bright red or mostly with blood

 Vomiting and convulsion are the signs in children under two(2) years

 There is sudden onset

 There is insomnia

8
  There is headache

 There is general malaise

 There is tiredness

 There may be excessive sputum production

 There may be chest congestion

Predisposing Factors

 A family history of pneumonia

 Alcoholism

 Smoking

Complications

 Bronchiectasis

 Pneumothorax

 Pyogenic foci

 Persisting lobar collapse

 Lung abscess

 Respiration failure

 Dehydration

 Emphysema, pleural effusion

 Recurrent pneumonia
9
Investigation

 Blood for culture and sensitivity text to discover organism

 Blood for erythrocyte sedimentation rate and leukocytes are found to be high.

 Lateral and posterior-anterior chest x-ray to localize the process determines the

presence or absence of fluid.

 Chest auscultation and percussion for dullness and decrease in breath sound.

 Sputum specimen for gram stain culture and sensitivity test to isolate the causative.

 Aspiration of pleural effusion

 Signs and symptoms manifested by the patient

Specific Medical Management

 The patient should be propped up in bed in a position that is comfortable and

encourage patient to cough up sputum

 If breathing is difficult (dyspnoea) and the client is cyanosed, oxygen therapy is

administered according to the body weight of the client.

 Antibiotics such as cloxacillin and injection penicillin are given to combat the

infection.

 Analgesic; paracetamol (Acetaminophen) is administered orally or rectally to relive

pain and control pyrexia

 Itaematinic: such as multivitamin syrup and capsules and gulper ferrous are also

given to anaemia

10
  Intravenous fluids example. Dextrose saline is also given to correct electrolyte and

fluid imbalance, to correct dehydration and to loosen and make sputum lighter to

expectorate.

NURSING MANAGEMENT

Psychological Care:

The client is reassured of the competency of staff and assured of possible measures to be

put in place to ensure speedy recovery from pneumonia. This is to relax the client and gain

his/her co-operation

Client and family should be given the chance to express their fears and anxiety. They

should also be given the opportunity to ask bothering question on the condition and

clarification should be given.

Rest and Sleep

Client should be nursed in a well prepared bed free from creases and cramps. Windows

should open to enhance ventilation. There should be a quiet environment to enhance sleep.

Visitors should be restricted to ensure adequate rest. Lightening system should be

regulated to client’s preference to ensure rest and sleep adequately. All procedures should

be performed at a go in order not disturbed client’s sleep. Warm beverages can be served

to induce sleep depending on the weather

11
Position

To facilitates easy breathing and also reduces stress on the heart and lungs. The patient is

put in fowler’s position, it also decreases oxygen demand, help in the expansion of lungs

and coughing out sputum, ensure adequate comfort and enhance speedy recovery.

Oxygen Administration

Prescribed oxygen should be administered if the client’s partial pressure of oxygen in

arterial blood palls below 55mmHg to 60mmHg. It should be regulated to suit client’s

condition. Proper oxygen fixation, mark and moistening should be ensured.

Observation and Monitoring

In observation, the patient’s vital signs such as temperature, pulse rate and respiration are

monitored ¼ hourly, ½ hourly, 1 hourly and 4 hourly depending on client’s condition and

should be recorded accurately. The weight should also be checked on daily basis with the

same scale to ascertain any weight loss and measures taken promptly. When client is on

intravenous infusion, the nurse should observe that the line is in the vein, Observe the site

for swelling and bleeding. The dripping rate should be monitored to ensure it drops at the

prescribed rate.

12
Sputum should be observed for blood, amount, odour, consistency and presence of any

material. This should be reported to the physician if any. Client should be observed for

desired and side effects of drugs administered. Client’s intake and output chart should be

maintained and recorded accurately to know the occurrences of any imbalance.

Auscultation should be done to observe the presence of crackles in breath sounds of client.

Signs and symptoms as well as complications of the condition should be observed.

Nutrition

Nutritional states of the client is very necessary in that it builds the body’s immunity to

resist infections, improves muscles tone and also promotes the therapeutic effect of drugs.

Client diet must therefore be planned with her mother; this will help boost appetite so that

client can eat well.

Client should be well breast feed and her diet must be well balanced in protein,

carbohydrate and vitamins to build immunity and promote recovery.

Validation of Data

Information was collected from patient mother and complimented by that in the patient’s

folder. The diagnosis was also confirmed by some of the signs and symptoms presented by

Fati Awudu.

13
Add to prove validity of the diagnosis was laboratory investigation carried out which all

reflected that of the literature. To suffice it, data collected and obtained were free from bias

and error and hence valid.

14
 CHAPTER TWO

ANALYSIS OF DATA

This chapter includes the analysis of the information gathered to identify the needs and

problems of the patient and family in order to find the appropriate solution to be

implemented. The following represent the comparison of the data with standard values in

text books which include causes, clinical features, diagnostic investigation, treatment and

complications.

15
 TABLE 1:

DIAGNOSTIC INVESTIGATIONS CARRIED OUT

DATE SPECIMEN INVESTIGATION RESULTS NORMAL VALUES INTERPRETATION REMARKS

12/01/2010 Blood Haemoglobin level 10.9g/dl Male:12-18g/dl There was slight anaemia Tablet folic acid 5mg daily

estimation Female:11-16g/dl X 30 days was prescribed

Children:11-14g/dl

12/01/2010 Blood Malaria parasite No malaria No malaria parasite No malaria infection No treatment was given

parasite should be seen

was seen

12/01/2010 Blood White blood cell 10.4 x 6.2 – 17 x 109/L No pathogenic infection. It No treatment was given

count 109/L was within the normal

range

12/01/2010 Blood Culture and Tubercle There should be no There was a bacterial Intravenous cefuroxime

sensitivity test bacillus bacteria growth growth 270mg tds X 7 days was

mycobacter prescribed

ium

16
Causes of Patient’s Disease

From the literature review, the causes of bronchopneumonia are from different types of

micro-organisms such as bacteria, viruses and fungi. Predisposing factors such as smoke,

aspiration of gastric content into the lungs and hypoventilation can lead to the disease

condition.

TABLE 2:

COMPARISON OF CLINICAL FEATURES OUTLINED UNDER LITERATURE

REVIEW WITH THOSE EXHIBITED BY CLIENT.

CLINICAL FEATURES IN CLINICAL FEATURES

LITERATURE REVIEW EXHIBITED BY CLIENT

1.There is a sudden onset 1.According to client’s relatives,

the condition occurred suddenly

2.There is pleuritic chest pain 2. Client had pleuritic pain

3. There is productive cough 3. Client experienced cough

4. There is chills 4. Client had chills

5. There is dyspnoea 5. Client experienced dyspnoea

6. There is tachypnoea with 6. Client experienced tachypnoea

intercostals recession

7. The sputum will be bright red or 7. Client’s sputum was not bright

mostly with blood red

8. Vomiting and convulsion are the 8. Client experienced vomiting but

initial sign in children under two no convulsion

17
 (2) years.

9. There is insomnia 9. Client experienced insomnia

10. There is headache 10. Client had headache

11. There may be wheezing sounds 11. Client did not manifest any

wheezing sound

12. There is general malaise 12. Client had general malaise

13. There is tiredness 13. Client manifested tiredness

14 There may be excessive sputum 14. Client did not produce

production excessive sputum

15. There may be chest congestion. 15. Client did not experience chest

congestion

Medical Treatment

The following drugs were prescribed for the client;

 Injection chloramphenicol 25mg q.i.d daily x 7 days

 Intravenous Gentamycin 46mg daily X 7 days

 Tablet folic acid 5mg daily X 30 days

 Syrup Zincovit 5mls daily X 30 days

 Suppository paracetamol 125mg stat then syrup paracetamol 10mls tds X 7 days

18
 TABLE 3:

PHARMACOLOGY OF DRUGS ADMINISTERED TO CLIENT

DATE DRUG DOSAGE/ROUTE OF CLASSIFICATION DESIRED ACTUAL SIDE EFFECTS

ADMINISTRATION EFFECTS ACTION AND REMEDIES

LITERATURE GIVEN TO CLIENT OBSERVED

12/01/10 Chloramphe 50 – 70mg 25mg q.i.d daily x 7 Antibiotic Binds to There was no sign Headache,

nicol /kg /day days ribosomal subunit of infection depression,

which interferes confusion.

with or inhibits None was

protein synthesis observed.

12/01/10 Gentamycin Adults: 40mg 46mg daily X 7 days Aminoglycosides Inhibits protein Infection was Skin itching,

daily x 5 days intravenously synthesis of controlled redness, rash,

intravenously. susceptible micro swelling.

organism

19
 Children: Non was observed.

2.5mg/kg 12

hourly

intravenously.

12/01/10 Folic acid Adult: 0.4mg / 5mg daily X 30 days Vitamins and mineral Stimulates normal There was an Bronchospasm,

day orally supplements erythropoiesis and increase in red malaise, pruritus

Children:0.3 nuclo-protein blood cell count ras.

mg / day synthesis Non was observed

12/01/10 Suppository Adults: 325- 125mg stat rectally Antipyretic and To relieve pain Client was Anorexia, liver

Paracetamol 650mg q.i.d x analgesic relieved of pain damage,

hours depression.

Children: Non was observed

480mg q.i.d x

6 hours.

20
12/01/10 Zincovit Adult: 10mls 5mls daily X 30 Haematinic To correct Provides mineral Nausea, vomiting,

daily x 7 days days orally anaemia by support and constipation,

Children: 5mls helping in the multivitamin diarrhoea and

daily x 7 days formation of red anorexia.

blood cells and Non was observed

aid in growth of

children and

boosting of

immunity.

21
Complications

With reference to the complications stated under the literature review, client did not

develop any of these complications.

Patient and Family Strengths

This refers to the ability of the client as well as the family in helping the health staff to

achieve the goals set for early recovery. During the care, it was observed that client was

sensitive to pain. Family members were very supportive especially with the provision of

information and visitation was also regular.

Other supports that were given were emotional, spiritual, physical and financial. Client was

a registered member of the National Health Insurance Scheme, thus her bills were taken

care of but the uninsured drugs were bought for by the relatives.

Health Problems

The following health problems were identified through observation and collection of data

from client and relatives to help provide good nursing care.

1. Client’s relatives were anxious

2. Client had pyrexia

3. Client had breathlessness

4. Client experienced insomnia

5. Client’s relatives had no knowledge on disease condition

6. Client experienced vomiting

22
Nursing Diagnosis

The following nursing diagnoses were formulated for client and family;

1. Anxiety related to unknown outcome of disease condition on the part of the aunty.

2. Alteration in body temperature (pyrexia 38.4OC) related to inflammatory process.

3. Breathlessness related to congestion in the nostrils

4. Sleep pattern disturbance (insomnia) related to cough

5. Knowledge deficit related to unknown outcome of disease condition

6. Potential fluid volume deficit (vomiting) related to the loss of body fluids

23
 CHAPTER THREE

PLANNING FOR PATIENT AND FAMILY CARE

Planning for the client and family care is a process which involves planning nursing

strategies or intervention required to reduce, eliminate or prevent client and family health

problems that has been diagnosed. It allows full involvement of the client and family in

identifying the actual and potential problem of the client and also setting a goal and

objectives.

Nursing Care Plan

A nursing care plan is a written scheme or a goal for nursing action. The care plan provides

continuity of care and directions about what needs to be documented and what is to be

done. It gives direction to the staff as to how they should go about achieving the set goals

correctly.

Objectives and Outcome Criteria

The under listed objectives and outcome criteria were set for the client and family.

   1. Client’s family will be relieved of anxiety within 3 hours as evidenced by their

facial expression.

(b) Client’s family verbalizing that there is relieved of their anxiety.

    2. Client’s body temperature will be reduced within 24 hours as evidenced by client’s

temperature reducing to 37.2 degrees Celsius.

(b) Client’s body feeling cold on touch

24
 3. Client will have a normal breathing pattern within 2 hours as evidenced by client

breathing well in upright position.

(b) Nurse observing that client’s breathing pattern is within the normal range of 24 to

30 cycles per minute.

4.     Client will be able to sleep well within 48 hours as evidenced by nurse observing

that client slept throughout the night without coughing.

(b)   Client sleeping for 2-3 hours during the day.

5.  Client’s mother will know more about the disease condition within 4 hours as

evidenced by the questions being asked by her about the disease condition.

6. Client will have a normal fluid volume within 30 minutes as evidenced by client’s

vomiting subsiding.

25
 TABLE 4:

NURSING CARE PLAN

DATE & NURSING OBJECTIVE/ NURSING NURSING DATE & EVALUATION SIGNATURE

TIME DIAGNOSIS OUTCOME ORDERS INTERVENTION TIME

CRITERIA

12/01/2010 Anxiety related Client and family 1. Reassure 1. Client and family 12/01/2010 Goal fully met as

8:00pm to unknown will be relieved of client and were reassured that 10:00pm shown by their

outcome of the anxiety within 2 family. she would she will facial expression,

disease on the hours as evidenced recover within the also client’s

part of the by shortest possible time family verbalized

mother. a) Their facial and discharge from the that they are

expression hospital. This was relieved.

b) Client’s done to relieve and

family allay them of anxiety.

verbalizing

that they
2. Allow them

26
are relieved to express their 2. Client and family

fears and were allowed to

anxiety. express their fears and

anxiety by asking

questions related to

the hospitalization.

This was done for

them to know they are

in safe hands of

competent staffs that

are willing to listen to

them.

3. Explain to

them the
3. Hospitalization and
importance of
its importance were
hospitalization.

27
 explained to client and

her family. This was

done to correct their

perception of being in

prison or any strange

place but to relax her

for quick recovery.

4. Allow them

to ask

questions and
4. Client’s family
answer them in
members were
simple and
allowed to ask
clear language.
questions that concern

client’s condition.

This made them feel

28
 relax and have

maximum confidence

in the staff towards

her quick recovery and

discharge from the

hospital.

13/01/2010 Alteration in Client’s body 1. Reassure 1. Client and mother 14/01/2010 Goal fully met as

11:00am body temperature will client and were reassured that 11:00am client’s

temperature reduce within 24 mother. increased body temperature

(pyrexia hours as evidenced temperature is a sign reduced to 35.0

38,4OC) related by and symptom of the degrees Celsius

to a) Client’s disease condition and and her body felt

inflammatory temperatur that all measures will cold on touch.

process e reducing be put in place to

29
 to 35.0OC. bring the temperature

b) Client’s to a normal range.

body

feeling

cold on

touch.
2. Remove 2. Extra clothes on
extra clothes client were removed.

This was to allow air

circulate around her

body

3. Take vital
3. Vital signs
signs.
especially temperature

was checked and

recorded.

30
4. Tepid

sponge client. 4. Client was tepid

sponged with tepid

water from head to toe

leaving drops of water

on the skin. This was

done to keep the body

warm and to reduce

temperature.
5. Open

windows.
5. Nearby windows

were opened to allow

air into the ward to

reduce the body’s

temperature.
6. Serve

prescribed

31
 drugs. 6. Prescribed drug of

paracetamol syrup

10mls tds X 7 days

was administered to

reduce temperature.

14/01/2010 Breathlessness Client will have a 1. Reassure 1. Client and mother 14/01/2010 Goal fully met as

8:00am related to normal breathing client and were reassured that the 10:00am client breaths well

congestion in pattern within 2 mother. breathlessness is a in an upright

the nostrils hours as evidenced sign of the condition position within

by and measures would the normal range

a) Client be put in place to help of breathing

breathing improve her breathing pattern.

well in pattern. This was done

upright to allay their fears

position.

32
b) Nurse

observing

that client’s 2. Put client in 2. Client was put in an

breathing an upright upright position to aid

pattern is position. in her breathing.

within
3. Remove 3. Client’s tight
normal
tight clothes. clothes were removed
range of
from her body
24-30
especially around the
cycles per
neck. This was done to
minute.
aid in breathing.

4. Provide
4. Adequate
adequate
ventilation was
ventilation by
provided as fans were

33
 putting on fans. put on and windows

opened.

5. Oxygen was
5.Provide
administered when
oxygen when
necessary to aid her to
necessary.
breath well.
.

15/01/2010 Sleep pattern Client will be able 1. Reassure 1. Client and mother 17/01/2010 Goal fully met as

8:30am disturbances to sleep well client and were reassured that 8:30am client slept

(insomnia) within 48 hours as mother. cough is a symptom of through out the

related to evidenced by the condition and all night without

cough a) Nurse measures will be put coughing and also

observing in place to reduce the slept for 2-3 hours

that client frequency of the during the day.

slept cough. This was done

34
 through out to allay their fears and

the night gain co-operation.

without

coughing.
2. Make a 2. A comfortable bed
b) Client
comfortable was made for client to
sleeping
bed. enhance sleep.
for 2-3

hours

during the
3. Give client a 3. Client was given a
day.
warm bath. warm bath with tepid

water, soap and

sponge to enhance

sleep.
4. Nurse client
4. Client was nursed in
in a quite
a quite room as
room.
visitors were restricted

35
 and volumes of

television seta

minimizes. This was

done to induce sleep.

5. Serve warm
5. Warm beverages
beverages.
such as Milo drink

was served to enhance

good sleep.

16/01/2010 Knowledge Client’s mother 1. Reassure 1. Client and her 16/01/2010 Goal fully met as

8:00am deficit related will know more client and her mother were reassured 12:00pm seen by client’s

to unknown about the disease mother. that the disease mother facial

outcome of the condition within 4 condition is like any expression and

disease hours as evidenced other disease and that also, she was able

condition by she will be educated to ask questions

36
a) The on the condition. about the disease

questions condition

being

asked by
2. Put client 2. Client and mother
her about
and mother in were put in a
the disease
a comfortable comfortable position
condition.
position. by assuming an
b) Her facial
upright position. This
expression
was done to relax and

win their co-operation.

3. Assess
3. Client’s mother’s
client’s
knowledge on the
mother’s
disease condition was
knowledge on
assessed. This was

37
the condition. done to gain her co-

operation.

4. Educate 4. Client and relative

client and were educated on the

relative on the disease condition, its

disease signs and symptoms,

condition. causes, complications

and measures to

prevent its

reoccurrence.

5. Allow for
5. Questions were
questions.
welcomed and

answered to their

38
 satisfaction to clear

any misconception.

16/1/2010 Potential fluid Client will have a 1. Reassure 1. Client and her 16/1/2010 Goal fully met as

2:30 pm volume deficit normal fluid client and mother were reassured 3:00 pm client stopped

vomiting within the

(vomiting) volume within 30 mother that everything would
set time.
related to the minutes as be done to stop the

loss of body evidenced by vomiting.

fluids client’s vomiting 2. Provide 2. A sputum mug was

subsiding sputum to provided to client to

client vomit and spit into it.
3. Position 3. Client was placed in
client to the upright position to
prevent prevent aspirating the
aspiration vomitus.
4. Maintain 4. Intravenous Normal

hydration Saline was

39
 administered to client

to maintain her body’s

fluid and electrolyte

balance.
5. Withhold
5. Client’s mother was
oral foods till
advised not to give
vomiting stops
any food by mouth till

the vomiting stops.

6. Give water
6. Client was given
to client to
water to rinse her
rinse her
mouth to restore her
mouth
appetite.
7. Observe the
7. The vomitus in the
vomitus
sputum mug was

observed for amount

and appearance and

40
recorded in the nurses’

notes.

41
 CHAPTER FOUR

IMPLEMENTING PATIENT AND FAMILY CARE PLAN

Implementation is the administration of nursing orders according to the nursing care plan.

The nursing care given through out client’s stay on the ward C5 of Komfo Anokye

Teaching Hospital was aimed at meeting her psychological, physical and physiological

needs such as her nutritional status and vital signs

SUMMARY OF ACTUAL NURSING CARE RENDERED TO PATIENT AND

FAMILY

The nursing management of the client started on the day of admission to the day of

discharge. It was aimed at promoting speedy recovery as well as preventing further

complication. During the period of admission, daily ward round, routine care such as

checking of vital signs and recording, bed making and administration of drugs were carried

out.

Specific cares carried out according to client’s needs on particular days are summarized as

follows;

FIRST DAY OF ADMISSION: 12TH JANUARY, 2010

Client was admitted to ward C5 on 12th January, 2010 at 7:30pm as a trans-in case from

paediatric emergency unit (PEU) with Bronchopneumonia under the care the of Dr.

Owusu. She came to the ward carried at her mother’s back accompanied by a student nurse

42
Client and mother were warmly welcomed into the ward. The mother was offered a seat

and the client was admitted into a warm comfortable bed. She was alert and conscious but

looked ill.

Client’s mother was anxious and she was reassured that client would recover within the

shortest possible time and discharge from the hospital. This was done to allay and relieve

her of anxiety. Client’s mother was allowed to express her fears and anxiety by asking

related questions to the hospitalization and this was done for her to know that they were in

safe hand of competent staffs that are willing to listen to them.

Hospitalization and its importance were explained to client and mother. This was done to

correct their perception of being in prison or any strange place but to relax her for quick

recovery. Client’s mother was allowed to ask questions that concerned the condition. This

made them feel relaxed and have the maximum confidence in the staff towards her quick

recovery and discharge from the hospital.

Client was fed with light porridge together with breast milk as supper and her medications

were served to her. She was then bathed and made comfortable in bed to enhance sleep.

SECOND DAY OF ADMISSION: 13TH JANUARY, 2010.

According to the night nurse, she was given bed bath with warm water, soap and sponge.

Other personal hygiene routines were maintained and she was then groomed. She was

breastfed by her mother and her vital signs were checked and recorded. Her medications

especially intravenous Ringer Lactate was instituted since she was not feeding well.
43
During ward rounds, we were asked to continue with her medications. Client was

examined and her body was found to be hot on touch. Her mother was reassured that

increase in temperature is a sign and symptom of the disease condition and that all

measures would be put in place to bring the temperature to a normal range. Extra clothes

were removed on client and this was done to allow air circulate around the body. Her vital

signs especially the temperature was checked and recorded. This was done to serve as a

baseline for treatment and the appropriate nursing measures to be put in place.

Client was tepid sponged with tepid water from head to toe leaving drops of water on the

skin. This was done to keep the body warm and reduce temperature. Nearby windows were

opened to allow air into the ward to help reduce the body’s temperature as well as

prescribed drugs of syrup paracetamol 10mls tds X 7 days was administered to reduce

temperature. She was monitored closely and all routine nursing care was given to her

through out the day.

THIRD DAY OF ADMISSION: 14TH JANUARY, 2010.

According to the night nurse’s report, client had difficult in breathing during the night.

When I read the report, immediately client and her mother were reassured that the

breathlessness is a sign and symptom of the disease condition and measures would be

taken to improve her breathing pattern. This was done to allay their fears.

She was then put in an upright position to aid in breathing and tight clothes on her were

removed especially around the neck. This was done to aid in breathing. Adequate
44
ventilation was provided as fans were put on and windows opened. Oxygen was

administered when necessary to help her breath.

Client was breastfed and made comfortable in bed. She was reviewed during ward rounds

and we were asked to continue with oxygen therapy when necessary. Her vital signs were

checked and recorded and her medications were served to her. She was then made

comfortable in bed.

FOURTH DAY OF ADMISSION: 15TH JANUARY, 2010

According to the night nurse report, client could not sleep well through out the night due to

frequent coughing. Client was bathed and groomed, she was then breastfed and made

comfortable in bed. Her vital signs were checked and recorded as follows:

Temperature: 36.2 degree Celsius

Pulse:             120 beat per minute

Respiration: 25 cycles per minute

Weight: 11.2 kilo gram

She was served breakfast of porridge with nido after which her drugs were served to her.

Daily ward rounds was conducted after which her relatives were reassured that cough was

a sign and symptom of the condition and all measures would be put in place to reduce the

frequency of the cough. This was done to allay their fears and gain their co-operation. A

comfortable bed was made for client to enhance sleep. She was nursed in a quite room as

visitors were restricted and volume of television set minimized. This was done to induce

sleep. Her drugs were then served.

45
Client was given a warm bath with tepid water, soap and sponge to enhance sleep. She was

then made comfortable in bed to sleep.

FIFTH DAY OF ADMISSION: 16TH JANUARY, 2010

Client’s general condition was improved and satisfactory on this day and her mother was

very happy her daughter had regained her strength again. Client was very active in bed and

she gave the impression that she was ready to go home. She was bathed and groomed by

her mother and her vital signs were checked and recorded. Her drugs were served to her

and she was made comfortable in bed.

During ward rounds, we were asked to continue with the drugs. After ward rounds, client’s

mother was eager to know more about client’s condition so she was reassured that the

disease condition was like any disease condition and that she will be educated on the

disease condition. Client and mother were made comfortable and this was done to relax

them and win their co-operation.

Client’s mother’s knowledge on the condition was assessed; this was done to gain her co-

operation. She was educated on the disease condition, its signs and symptoms, causes,

complications and measures to prevent reoccurrence. Moreover, questions were welcomed

and answers were given in clear and simple way to clear any misconception.

46
After the education client’s mother fed her and client was made comfortable in bed. At

lunch time, client stated to vomit when she was fed her meal. She and her mother were

reassured and the appropriate nursing measures were put in place to stop the vomiting.

SIXTH DAY OF ADMISSION: 17TH JANUARY, 2010

Client was very well and strong on this day without any health problem so her mother was

reassured that she should be ready because she could be discharged at any time. Client’s

vital signs were checked and recorded and her drugs were then served. She was then made

comfortable in bed.

During ward rounds client was examined and she was discharged by the doctor. After ward

rounds client’s mother was accompanied to the revenue office with client’s folder for

client’s bill to be settled and a receipt was issued to client’s mother. Client’s mother was

educated on the need for continuation of care and drugs. The importance of review was

explained to her and she was reminded of the date. She was helped to pack her belongings.

Client was discharged from the admission and discharge book as well as the daily ward

state. Client’s mother expressed her gratitude to the staff and friends on the ward and bid

them goodbye. I escorted them to the car park and they left for their home around 4: 30

pm. Client’s bed linen was removed and the mattress disinfected with parazone 1:10 part

of water and later cleaned with savlon and dried.

47
PREPARATION OF PATIENT AND FAMILY FOR DISCHARGE AND

REHABILITATION

The preparation of patient and family for discharge and rehabilitation commenced on the

day of admission. It was made earlier to make client and family understand that

hospitalization is a temporal and she would be discharged home.

During admission it was observed that client and mother were anxious and client’s mother

lacked knowledge about the disease condition. They were reassured of the availability of

competent staff that were willing to care for her daughter. The causes, sign and symptoms,

management and prevention of the disease condition were explained to them.

They were also educated on the need to maintain good personal hygiene such as bathing,

grooming and proper hand washing before and after eating or visiting the toilet. Again, the

need to sweep, weed, scrub and proper disposal of refuse was encouraged to be practiced

in their environment. Client’s mother was further educated on her daughter’s exposure to

cold, irritant, gas, smoke and alcohol as these can trigger the condition. The need for

review was also explained and reminded of the date.

Any complication was encouraged to be reported for proper management and appropriate

treatment in the hospital. They were reminded on how to administer the remaining drugs at

home. Finally client was discharged on the 17th of January, 2010. Her bills were assessed

for proper documentation and her name, the date of discharge and bed number was entered

into the admission and discharge book as well as the daily ward state.

48
I informed client and her mother about my home visit and helped them pack their

belongings after which they were escorted to the car park for a car home.

Follow up/ Home Visit/ Continuity of Care

Follow up; home visit and continuity of care play an important role in the care of the client

and family after discharge. It helps in observing the health and environmental conditions of

the client and family as well as helping to know the predisposing factors and hazards

which could be dangerous to the health of the client and family.

First Home Visit

My first home visit was made whiles client was still on admission on the 13th of January,

2010. The visit was to help me know more about the residence of the prevailing

environmental conditions as well as her natural habitat on which health education would be

based. Client resides at Serwaba house number 49; block XIV, a suburb of Kumasi in the

Ashanti Region. It was not difficult locating client’s house since I was accompanied by her

younger mother.

A quick observation was made on the environment on entering the house. The environment

was well swept, proper drainage system and availability of public dust bins for disposal of

refuse. The house is built with cement blocks and roofed with aluminium roofing sheets. It

is a rented compound house with toilet and bathroom facilities. Their source of water is

pipe borne. Client sleeps with her mother and aunty. Some of the rooms in the house were

occupied by some of client’s relatives.

49
Client’s relatives were reassured of the possibility of client’s discharge within some few

days. They were allowed to ask questions that bothered them. I commended them on their

tidy environment and advised them to continue with that and also educated them on the

need to dispose the refuse in the public bins regularly. They expressed their appreciation

and with permission from them, I left the house and promised to visit them again when

Awudu was discharged.

Second Home Visit

On the 24TH of January, 2010 I made my second home visit. That was a week after client

was discharged. She was doing well and her relatives were very happy to see me.

Upon interaction, I got to know that she had been taken her remaining drugs and was

looking healthy. She was congratulated and relatives were encouraged to adhere to the

health education given to them during admission and discharge. Client’s mother was

reminded of the review date which was 1st February, 2010. I then informed them that, on

my next visit I will be accompanied by a public health nurse who will continue with the

care. Awudu’s relatives expressed their gratitude and accompanied me to the lorry station.

Third Home Visit

I made my third home visit with a public health nurse to client and family house some few

days after their review. They welcomed us by offering us seats after we had exchanged

greetings. I asked of Awudu’s condition and happily they responded she was well and

healthy. I emphasized on the education given to them already and introduced the public

health nurse to them. They were worried but I assured them that she is competent to
50
provide a holistic continuity of care to them. Since it was my last day of my therapeutic

relationship, I terminated my care and bid them good bye. They escorted us to the lorry

station for a taxi. The family was grateful for the care given to them.

51
 CHAPTER FIVE

EVALUATION OF CARE RENDERED TO PATIENT AND FAMILY

Evaluation is the last aspect of nursing process which judges and calculates the quality of

care rendered to patient and family. The nursing care given to the patient and family was

evaluated so as to determine whether the goals set were successfully achieved or not.

Statement of Evaluation

With maximum co-operation from client and relatives as well as support of the staff of

ward C5 of Komfo Anokye Teaching Hospital, the goals and objectives set were fully met.

On the 12th of January 2010, when client was admitted it was observed that client’s

relatives were anxious which was related to client’s hospitalization. Necessary nursing

orders were implemented and goal set was fully achieved as shown by their facial

expression, also client’s relatives verbalizing that they are relieved.

On the second day of admission, 13th January, 2010, goal set to reduce client’s increased

body temperature was fully achieved as client’s body temperature reduced to 35.0 degrees

Celsius and her body temperature felt cold on touch.

On the third day of admission, 14th January, 2010, the nursing order which was

implemented to meet client’s normal breathing pattern was met as client breathed normally

and the client observed that client’s breathing pattern was within the normal range of 24 -

30 cycles per minute.

52
On the fourth day of admission, 15th January, 2010, goal set to meet client’s sleeping

pattern disturbances was fully met as client slept throughout the night without coughing

and also slept foe 2-3 hours during the day.

On the fifth day of admission, 16th January, 2010, client’s mother looked worried because

she had no knowledge on the outcome of the disease condition. Goal was set and fully met

on the same day as seen by her facial expression and also the questions she asked about the

disease condition.

AMMENDMENT OF NURSING CARE PLAN FOR PARTIALLY MET OR

UNMET OUTCOME CRITERIA

Upon implementation of the nursing care rendered to client and family, it was observed

that all goals were fully met as the client recovered and was relieved of the health

problems. Therefore no amendment of objective set was made.

Termination of Care

The therapeutic relationship between the client, relatives and I came to an end after the

third home visit as it was the last aspect of interaction. However, the client and family were

made aware of this from the day of admission to prevent separation anxiety and

depression. Previous health education that had be given were repeated to them of its

importance. They were also educated on the predisposing factors, causes, signs and

symptoms, treatment as well as prevention of the condition. I thanked them and promised

to call anytime I had the chance. They were grateful and happy.

53
Summary

Fati Awudu, a one year 4 months girl was admitted to the children’s medical ward (C5) at

Komfo Anokye Teaching Hospital on the 12th January, 2010 at 7:30pm with a diagnosis of

bronchopneumonia. Nursing problems were identified during observation and interaction

with the client and family. They were; anxiety, pyrexia, breathlessness, insomnia and lack

of knowledge.

Objectives were set and nursing orders were well implemented to solve client and family’s

problems. These objectives were fully met at the time of discharge.

During follow ups and home visits client and family were advised to maintain their

environment clean. Her condition improved without any complication. Client’s mother was

advised to give client enough rest and sleep and also to breastfeed client regularly. She was

also educated on how to administer client’s drugs and to report to the hospital for regular

check ups. Client’s condition improved and was discharged on the 17th of January, 2010.

Conclusion

The patient and family care study is an aspect of nursing and it has been an educative

experience which has broadened my knowledge and understanding of the need for a

comprehensive nursing care using the nursing process approach of caring for the patient as

a unique individual.

54
It has also broadened my knowledge on bronchopneumonia, it causes, signs and

symptoms, management and how to prevent people from getting the disease. Again I wish

that clients would be given special and individualized care whenever they are sick. This is

because more attention is given to the patient and family when nursing process approach is

used.

Finally, I recommend that nurses most especially in the clinical area should be encouraged

and reminded to use the nursing process in the care of the patient as this will help give

appropriate and holistic care to all patients.

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 BIBLIOGRAPHY

Baee C.L (1998), Nurses’ Drug Guide, 2nd edition, Springehouse Corporation,

Pennsysvania, U.S.A.

Royle A.J. and Walsh M.(1992), Medical – Surgical and Related Physiology, 4th edition,

Bailliere Tindal, London, Britain.

Smeltzer S.C and Bare B.G. (1992), Brunner and Suddarth’s Textbook of Medical Surgical

Nursing, 7th edition, J.B. Lippincott Company, Philadelphia, U.S.A

Watson J.E. (1994), Medical Surgical and Related Physiology, 7th edition, W.B Saunders

Company, Philadelphia, U.S.A

Weller F.B (2001), Bailliere’s Nurses’s Dictionary, 23rd edition, Bailliere Tindal, London,

Britain

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 SIGNATORIES

NAME OF CANDIDATE: PREMPEH THERESA

SIGNATURE: …………………………………………………

DATE: ………………………………………………………….

NAME OF PRINCIPAL: MRS. BANSAH MATILDA

SIGNATURE: …………………………………………………..

DATE: …………………………………………………………..

NAME OF SUPERVISOR: MR. OPOKU ALBERT

SIGNATURE: ……………………………………………………

DATE: ……………………………………………………………

NAME OF WARD IN – CHARGE: MRS. THERESA ATOBRA

SIGNATURE: …………………………………………………..

DATE: …………………………………………………………..

57